30-day mortality after systemic anti-cancer therapy (SACT) – Using and evaluating the NCEPOD audit toolkit


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Alison Berner1, Mahalakshmi Mohan1, Ian Grant1
1Barking, Havering & Redbridge University Hospitals NHS Trust, London, UK

Background

NCEPOD 'For better, for worse?' (2008) raised concerns regarding care of patients dying within 30 days of systemic anti-cancer therapy (SACT) and made a recommendations for management before, during and after chemotherapy, including audit of patients dying within 30 days of SACT using a toolkit. However, few hospitals have conducted this to date. We report results from a London District General Hospital and suggest modifications to the toolkit to create a template for use across London Cancer integrated services.

Method

Retrospective audit of case notes for patients dying within 30 days of SACT between 1st January and 31st June 2012 using the NCEPOD toolkit. Results were compared to national NCEPOD figures and presented at local clinical governance meeting and London Cancer Expert Chemotherapy Group.

Results

28 patients died within 30 days of SACT over the audit period, representing 0.73% of SACT episodes, lower than the national average (NA) of 2.22% derived from NCEPOD data. Other key findings include only 69% of patients with potential toxicities recorded on the consent form (NA =75%) and poor record of pre-chemotherapy assessments including ECOG score (43%, NA=87%) and response to treatment (29%, NA=54%), though treatment toxicity recording was just above NA (68% vs 64%). Overall assessment of care was hampered by failure of the toolkit to record information including chemotherapy intent and cycle, cause of death and deficiencies in care.

Conclusion

Our hospital had low mortality within 30 days of SACT though there was room for improvement in consenting and pre-chemotherapy assessments. Changes implemented include use of electronic prescribing systems to record pre-chemotherapy assessments and use of dated, patient identified toxicity checklists attached to consent forms. We recommend extension of the audit toolkit to include more qualitative information to better evaluate care and improve outcomes across new integrated cancer services including London Cancer.